An executive order in 2004 by the president called for the implementation of electronic health records for all those living in the United States by 2014.  With this date nearing, the scrambling continues to determine the best practice for particular healthcare niche groups and care facilities.

Throughout the implementation process, particularly in ambulatory care, particular barriers have been identified.  These barriers include communication, standardization, funding and interoperability.  Although some ambulatory care facilities have implemented EHRs with great success, others have found struggles along the way in an effort to become paperless.  This article addresses some of the common issues found through integrating EHR within ambulatory care and provides ways to work around these barriers.

What about the Patient Record

The discussion of what to do with the paper record generally arises in the early stages of EHR implementation.  There are a wide number of factors that should be considered.  The largest benefit received from the integration of an electronic health record system is the elimination of paper records and charts.  Paper records are seen as being highly inefficient as human error and space are common issues.

One of the first steps during the change-over is to determine which documents should be scanned and which information should be entered by hand.  Part-time employees can be utilized during this process that is short-lived and only has to be done once.

A critical data checklist is often used to help list the items that need to be entered by hand.  These items may be immunization records, allergies, current medications being taken by the patient, and growth histories.  Once this process takes place and the system is go-live, the chart can be stored until it is approved to be legally destroyed.

Training Requirements

Surprisingly, one of the most neglected oversights of the EHR implementation is staff training.  This part of the integration process should not be overlooked because it is crucial in staffing success.  A lack of proper training can lead to communication breakdown and consequently, negative feelings toward the EHR integration.

Some of the most successful integrations reveal that the facility underwent week-long training for their staff members and physicians.  A vendor-facilitated training session offers information and detailed walk-through on billing, coding, voice dictation, messaging, tasking, documentation and e-prescribing.  Other training sessions may be set up that are specific to the needs of the ambulatory care facility.

Vendor training can be expensive and some facilities have opted to have one key player representative of their organization receive the training and then re-train staff during sessions throughout the upcoming months following EHR integration.

Training costs should not be overlooked when putting together a budget for the integration of EHR.  However, ‘training the trainer’ models, especially in large facilities, proves to be more budget friendly than training sessions that are broken up into separate staff, nursing and physician training modules.

While other barriers may arise, it is important to keep an open mind during the process.  Good vendor distributors of EHR system software provide ongoing assistance, knowledge and expertise to make the integration seamless and worrisome-free.